title: Surgical versus nonsurgical treatment of infected pancreatic necrosis: more arguments to change the paradigm.
abstract: OBJECTIVE
  This study aimed to compare primary surgical versus nonsurgical treatment in a series of patients with infected pancreatic necrosis (IPN) and to investigate whether the success of nonsurgical approach is related to a less severe disease.
  
  
  METHODS
  Thirty-nine consecutive patients with IPN have been included and further subdivided into two groups: primary surgical (n = 21) versus nonsurgical (n = 18). Outcome measures were the differences in mortality, morbidity, and pancreatic function. Comorbidity, organ failure, and other severity indexes were compared between the two groups.
  
  
  RESULTS
  Mortality occurred in 16.7% of cases in the nonsurgical group versus 42.9% in the surgical group. In the primary nonsurgical group, seven were operated on due to failure of initial conservative treatment. In this latter group, mortality was 28.6% and was performed significantly later than in the primary surgical group. The group of primary surgical treatment was associated with a significant higher rate of multiple organ failure (MOF) at IPN diagnosis, new onset or worsening of organ failure, and MOF and nosocomial infection after surgery.
  
  
  CONCLUSIONS
  Initial nonsurgical approach in IPN is associated with better results both in cases which respond to this treatment as well as in those who, failing this conservative approach, have to be operated on after a delayed period. Primary surgically treated patients had a more severe disease at the time of IPN.
authors.affiliation: Department of Gastroenterology, Hospital Clínico, University of Valencia, Avda. Blasco Ibáñez, 17, 46010, Valencia, Spain. isabel.pascual-moreno@uv.es
authors.forename: Isabel
authors.initials: I
authors.lastname: Pascual
authors.forename: Luis
authors.initials: L
authors.lastname: Sabater
authors.forename: Ramón
authors.initials: R
authors.lastname: Añón
authors.forename: Julio
authors.initials: J
authors.lastname: Calvete
authors.forename: Gema
authors.initials: G
authors.lastname: Pacheco
authors.forename: Elena
authors.initials: E
authors.lastname: Muñoz
authors.forename: Javier
authors.initials: J
authors.lastname: Lizarraga
authors.forename: Juan
authors.initials: J
authors.lastname: Sastre
authors.forename: Andrés
authors.initials: A
authors.lastname: Peña
authors.forename: Francisco
authors.initials: F
authors.lastname: Mora
authors.forename: Jaime
authors.initials: J
authors.lastname: Pérez-Griera
authors.forename: Joaquin
authors.initials: J
authors.lastname: Ortega
authors.forename: Adolfo
authors.initials: A
authors.lastname: Benages
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003646:Debridement; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D010180:Pancreatectomy; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents